Application for Transition to Teaching Tuition for the Master of Arts in Teaching - Year III

Mathematics and Science

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1.
What is your last name?

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2.
What is your first name?

3.
What is your middle or maiden name?

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4.
What year were you born?

5.
What is your UCA Student Identification Number?

6.
What are the last four digits of your Social Security Number?

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7.
What is your street address?

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8.
In what city do you live?

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9.
In what state or U.S. territory do you live?

Other (please specify)

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10.
In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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11.
What is your home telephone number?

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12.
What is your cell telephone number?

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13.
What is your work telephone number?

14.
What is your fax telephone number?

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15.
What is your e-mail address?

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16.
Are you currently employed?

Yes

No

Unemployed

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17.
If you are employed, what type of work are you currently employed to do?

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18.
If you are currently unemployed, what type of work have you performed in the past five years?

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19.
Select the year in which you completed your undergraduate or bachelor's degree below:

Other (please specify)

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20.
Where did you complete your undergraduate degree?

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21.
What is the highest level of school you have completed or the highest degree you have received?

Bachelor's Degree

Master's degree

Specialist degree

Doctorate degree

Other (please specify)

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22.
Have you been admitted to the UCA Graduate Program? (Partnership for Transition to Teaching funds are disbursed to candidates who have been fully admitted to the UCA graduate school)

Yes

No

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23.
What is your undergraduate cumulative G.P.A?

24.
If you have been admitted to the UCA MAT Graduate Degree Program, which of the following major subject areas are you seeking a teaching license?

Mathematics 7-12

Science - Life/Earth Science 7-12

Science - Physical/Earth Science 7-12

Middle Grade - Mathematics and science

Other (please specify)

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25.
In what subject area did you receive your undergraduate bachelor of science or other degree?

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26.
You must have at least 30 college credit hours in the content area in which you are seeking licensure. For example, for a 7-12 math license, you must have at least 30 credit hours in mathematics, unless you are seeking licensure in middle grade mathematics and science. You may earn any additional courses while completing the MAT degree. Do you understand this requirement?

Yes

No [Please contact the MAT office.]

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27.
Have you completed 20 hours of observation in one of the following school districts? Schools Districts that apply below:

Little Rock School District

North Little Rock School District

Carlisle School District

Harrison School District

Watson Chapel School District

Pine Bluff School District

El Dorado School District

West Memphis School District

Dollarway School District

White Hall School District

None

Other (please specify)

28.
Have you served as a substitute teacher in one of the above school districts?

Yes

No

Other (please specify)

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29.
Mark the school in which you have served as a substitute school teacher?

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30.
List the grade level in which you completed 20 hours of observation

N/A

Middle Level

7th

8th

9th

10th

11th

12th

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31.
Select the subject area below in which you completed 20 hours of observation.

N/A

Mathematics - Geometry

Mathematics - Trigonometry

Mathematics - Calculus

Science - Physical Science

Science - Physics

Science - Biology

Science - Earth

Other (please specify)

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32.
If you have not completed the 20 hours of observation, have you substitute taught?

Yes

No

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33.
I understand that by accepting tuition from the Partnership Transition to Teaching Grant funds, I am committed to completing the MAT program or I must refund grant funds to the project.

Yes

No

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34.
I understand that if I am a qualified applicant for a mathematics or science teaching position and offered a teaching position in one of the partnership school districts, I must accept the position and teach in the partnership school district for a period of at least three years or refund tuition and fees to the program.

Yes

No

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35.
Where did you learn about the UCA Partnership for Transition to Teaching funding opportunity?

Television station

Newspaper

Radio station

UCA Webpage

Partnership school districts

Direct recruitment mail or e-mail

Recruitment flyers

Unemployment office

Veteran's office

Other (please specify)

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36.
Please list any questions or concerns you have about the Partnership for Transition program.